September 27, 2018
2 min read

Adolescents prefer open-system e-cigarettes

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Photo of Robert McMillen
Robert McMillen

Adolescents are more likely to use open-system e-cigarettes, which may pose health and injury risks, according to research published in Pediatrics.

Robert McMillen, PhD, a professor in the department of psychology and associate director of the Social Science Research Center at Mississippi State University, and colleagues reported that there are two types of e-cigarettes — open systems, with refillable nicotine systems, and closed systems, which are either disposable or use disposable cartridges. Most studies on people’s preferences of e-cigarettes have focused on adults, and the results have shown that the open-system devices tended to be more popular among the two types, they wrote.

“Each type of [e-cigarette] system presents somewhat unique challenges to public health,” McMillen told Infectious Diseases in Children. “The closed systems are typically produced and marketed by tobacco companies, which have an established history of manipulating cigarettes to be more addictive and designing marketing campaigns to attract youth.”

The FDA has recently cracked down on the sale and marketing of e-cigarettes to youth. The agency issued more than 1,300 warning letters and fines to retailers who illegally sold JUUL, a closed-system e-cigarette brand, and other e-cigarette products to minors

The open-system e-cigarettes, which are refillable with nicotine solutions, “have struggled with consumer product safety issues,” McMillen said. “This is problematic given that there is currently no regulatory oversight over these products or e-liquids. So, in addition to informing counseling strategies, our findings also suggest an additional set of health and injury risks arising from a tendency to use open-system e-cigarettes.”

McMillen noted that at the time that data were collected, open-system e-cigarettes tended to deliver higher levels of nicotine to the brain than most closed-system e-cigarettes.

McMillen and colleagues used data from waves 1 and 2 of the Population Assessment of Tobacco and Health trial, a nationally representative longitudinal study, to assess the types of e-cigarettes used by adolescents and the frequency with which they were used. Wave 1 of the study was conducted between September 2013 and December 2014, and included 13,651 adolescents. McMillen and colleagues found that 2.1% of those adolescents were regular e-cigarette users in the prior 30 days. The second wave of the study consisted of 12,172 adolescents, including 2.8% who were regular e-cigarette users in the prior 30 days.

The researchers reported that e-cigarette users were much more likely to use rechargeable devices compared with disposable devices (wave 1, 76%; wave 2, 82.9%) and to use refillable devices compared with the nonrefillable varieties (wave 1, 66.6%, wave 2, 84.4%). The e-cigarette users also tended not to use the cartridge-based e-cigarettes (wave 1, 33.7%; wave 2, 20.5%).

Those who smoked e-cigarettes mostly used flavored varieties (wave 1, 87.5%; wave 2, 89.4%).

The researchers said that rechargeable or refillable e-cigarette use was associated with an increased frequency of use (P < .05).

Although most users in wave 1 (70.2%) did not continue to use e-cigarettes in wave 2, those who had reported using closed systems in wave 1 had progressed to rechargeable and refillable e-cigarettes in wave 2.

“The study demonstrates that adolescent users prefer open-system e-cigarettes, especially the more frequent users” McMillen said. “Targeted counseling strategies should highlight the unique risks of these systems with potentially higher levels of nicotine and weaker quality controls.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.